STD, HIV, and TB Section
P.O. Box 64975
St. Paul, MN 55164-0975
651-201-5414
www.health.state.mn.us
Companion Text for the Slide Set:
Minnesota HIV/AIDS Prevalence & Mortality Report, 2015
Overview
The Minnesota HIV/AIDS Prevalence & Mortality Report, 2015 contains
estimates of HIV/AIDS prevalence (the number of persons living with HIV or AIDS) and
mortality in Minnesota. These estimates can be used to help educate, plan for HIV/AIDS
services and develop policy.
Data Source
In Minnesota, laboratory-confirmed infections of human immunodeficiency virus
(HIV) are monitored by the Minnesota Department of Health (MDH) through an active
and passive surveillance system. State rules (Minnesota Rule 4605.7040) require both
physicians and laboratories to report all cases of HIV infection (HIV or AIDS) directly to
MDH (passive surveillance). In June 2011, an amendment to the communicable disease
reporting rule was passed, requiring the report of all CD4 and viral load test results,
improving the completeness of passive reporting in Minnesota, and better allowing for
the monitoring of disease progression. Additionally, regular contact is maintained with
several clinical sites to ensure completeness of reporting (active surveillance). MDH staff
also performs routine death matches with state and national data as to ensure correct vital
status in the surveillance system. All of the data presented in this report come from MDH
HIV/AIDS Surveillance System.
Data Limitations
The prevalence estimate is calculated by totaling the number of HIV and AIDS
cases diagnosed through December 31, 2015 who are not known to be deceased and
whose most recently reported state of residence was Minnesota. It bears noting that
persons who are HIV-infected but not yet tested are not included in this prevalence
estimate. Migration (known HIV-infected persons moving in or out of the state) also
Companion Text for the Minnesota HIV/AIDS Prevalence & Mortality Report, 2014 Slide Set
affects the estimate. Refer to the HIV/AIDS Prevalence & Mortality Technical Notes for
a more detailed description of data inclusions and exclusions.
Factors that impact the completeness and accuracy of the available surveillance
data on HIV/AIDS include the level of screening and compliance with case reporting.
Thus, any changes in numbers of infections may be due to one of these factors, or due to
actual changes in HIV/AIDS occurrence.
National Context
According to the Centers for Disease Control & Prevention (CDC), an estimated
1.2 million persons in the United States over the age of 13 were living with HIV/AIDS,
with 14% undiagnosed and unaware of their HIV infection 1. The number of people
specifically living with diagnosed AIDS in the United States has been increasing steadily
since 1985 and an estimated 509,845 were living with AIDS at end of 2012. 2
Overview of HIV/AIDS in Minnesota, 1990’s-2015
The annual number of new HIV and AIDS cases increased steadily from the
beginning of the epidemic to the early 1990s. Beginning in 1996, both the number of
newly diagnosed AIDS cases and the number of deaths among AIDS cases declined
sharply, primarily due to the success of new antiretroviral therapies including protease
inhibitors. These treatments do not cure, but can delay progression to AIDS among
persons with HIV (non-AIDS) infection and improve survival among those with AIDS.
These treatments have been shown to be effective at preventing transmission of HIV.
Over the past decade, the number of HIV/AIDS cases diagnosed has remained relatively
stable with an average of 319 cases diagnosed each year. By the end of 2015, an
estimated 8,215 persons with HIV/AIDS were assumed to be living in Minnesota. 3
1
Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care
objectives by using HIV surveillance data—United States and 6 dependent areas—2012. HIV Surveillance
Supplemental Report 2014;19(No. 3). http://www.cdc.gov/hiv/library/reports/ surveillance/. Published
November 2014. Accessed April 20, 2015
2Centers for Disease Control and Prevention. HIV Surveillance Report, 2013; vol. 25.
http://www.cdc.gov/hiv/library/reports/surveillance/. Published February 2015. Accessed April 20, 2015
3
This number includes persons whose most recently reported state of residence was Minnesota, regardless of residence at time
of diagnosis. This estimate does not include persons with undiagnosed HIV infection.
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Companion Text for the Minnesota HIV/AIDS Prevalence & Mortality Report, 2014 Slide Set
Persons Living with HIV/AIDS in Minnesota, 2015
Among the estimated 8,215 prevalent cases in Minnesota, 4,349 are diagnosed
with HIV (non-AIDS) and 3,866 are diagnosed with AIDS. The majority (84%) of
prevalent cases reside in the seven-county metropolitan area surrounding the Twin Cities
of Minneapolis and St. Paul (Hennepin, Ramsey, Anoka, Carver, Dakota, Scott, and
Washington counties). Although HIV infection is more common in communities with
higher population densities and greater poverty, there are people living with HIV or
AIDS in 98% of counties in Minnesota.
Gender & Race/Ethnicity
Seventy-six percent (76%) of prevalent HIV/AIDS cases are males. Broken down
by race/ethnicity, 58% of male cases are white, 21% African American, 10% Hispanic,
3% black African-born, 1% American Indian, 2% Asian/Pacific Islander, and 3% are
persons of multiple or unknown race. In total, 39% of males living with HIV/AIDS are
among men of color whereas only 17% of the general male population comprised of
people of color. Among female cases, the distribution is even more skewed toward
women of color: 34% black African-born, 27% African American, 24% white, 7%
Hispanic, 3% American Indian, 2% Asian/Pacific Islander, and 3% persons of multiple or
unknown race. Thus, 73% of prevalent female HIV/AIDS cases are among women or
color whereas only 17% of the general female population in Minnesota is comprised of
women of color.
Please note that race is not considered a biological reason for disparities related to
HIV/AIDS experienced by persons of color. Race, however, can be considered a marker
for other personal and social characteristics that put a person at greater risk for HIV
exposure. These characteristics may include, but are not limited to, lower socioeconomic
status, less education, and less access to health care.
Beginning in 2012, MDH began estimating the number of MSM living in
Minnesota. Men who have sex with Men have the highest rate of persons living with
HIV/AIDS than any other sub-group. In 2015, the estimated rate of people living with
HIV/AIDS among MSM was 4,891.8 per 100,000 population. This is more than 70 times
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Companion Text for the Minnesota HIV/AIDS Prevalence & Mortality Report, 2014 Slide Set
higher than the rate among non-MSM men (67.4 per 100,000 population). It’s important
to note that MSM contains cases from all racial/ethnic categories and therefore cannot be
directly compared to the rates by race/ethnicity. For more information on how this was
estimated, see the HIV/AIDS Prevalence & Mortality Technical Notes.
Age
Seventy percent (71%) of persons living with HIV/AIDS in 2015 are currently 40
years of age or older. As with new cases, there are differences by gender in the age of
living cases. While males age 25 to 34 account for 14% of male living cases, females of
the same age account for 18% of female living cases.
With the advent of therapies that delay progression to AIDS and death for those
living with HIV infection the population of living cases has aged over time. In 2015,
persons age 50 and older accounted for 44%, or more than one in three persons living
with HIV in Minnesota, compared to 16% in 2002.
Mode of Exposure
In 2015, MDH used a risk re-distribution method to estimate the mode of
exposure among cases with unknown risk. For additional details on how this was done
please read the HIV Prevalence and Mortality Technical Notes. All mode of exposure
numbers referred to in the text are based on the risk re-distribution.
The proportions of living cases attributable to particular modes of exposure differ
among gender and race groups. While male-to-male sex (MSM or MSM/IDU) accounts
for an estimated 96% of white male cases, it accounts for a smaller proportion of cases
among men of color. For example, MSM and MSM/IDU account for 84%, 75%, and
12.5% of Hispanic, African American, and African-born males living with HIV in
Minnesota, respectively. The estimated percent of male cases that identified IDU as a
risk factor is higher for African Americans (12%), American Indians (14%), and
Hispanics (8%). The percentage of cases with a risk of IDU among Asian, white, and
African-born males are estimated at 3%, 2%, and 0.5%, respectively. Similar to the
MSM category, IDU may be underreported due to social stigma.
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Companion Text for the Minnesota HIV/AIDS Prevalence & Mortality Report, 2014 Slide Set
Across all race/ethnicity groups, females most frequently report heterosexual
contact as their mode of HIV exposure. However, IDU also accounts for a large
percentage of female cases among most race/ethnicity groups. The largest estimated
percentage of IDU cases are among American Indians (19%), followed by whites with
16%, African Americans with 13% and Hispanics with 8%. Among Asian females,
heterosexual contact accounted for an estimated 82% of cases, and IDU for an estimated
2%. However, the number of prevalent cases among Asian/Pacific Islander females is
quite small (n=48), so the results need to be interpreted very carefully. Finally, while
African-born women make up the largest proportion (34%) of females living with HIV in
Minnesota, they account for less than one percent of the IDU cases among HIV+ women.
Special Populations
Between 1990 and 2014, the number of foreign-born persons living with
HIV/AIDS in Minnesota increased substantially, especially among the African-born
population. In 1990, 50 foreign-born persons were reported to be living with HIV/AIDS
in Minnesota, and by 2003 this number had increased twelve-fold to 692 persons. In
2015, the total number of foreign-born persons living with HIV/AIDS in Minnesota was
1,785, a 6% increase from 2014. This trend illustrates the growing diversity of the
infected population in Minnesota and the need for culturally appropriate HIV care
services and prevention efforts.
The characteristics of foreign-born persons living with HIV/AIDS in Minnesota
differ from U.S.-born, especially in gender. While females account for 18% of cases
among U.S.-born persons, they account for 44% of foreign-born cases. This is especially
noticeable among African-born cases, where women account for 57% of those living with
HIV/AIDS in Minnesota. The gender distribution among cases born in Latin America/the
Caribbean is similar to that of U.S.-born cases, where 17% of prevalent cases are among
women.
Seven countries (Ethiopia, Mexico, Liberia, Kenya, Somalia, Cameroon, and
Sudan) account for a majority (64%) of living foreign-born cases, however there are 95
additional countries represented among the 1,748 foreign-born persons living with HIV
infection in Minnesota.
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Companion Text for the Minnesota HIV/AIDS Prevalence & Mortality Report, 2014 Slide Set
HIV/AIDS Mortality in Minnesota
The number of deaths 4 among all people living with HIV infection in Minnesota
decreased dramatically between 1995 and 1997 and has remained relatively constant over
the past decade. In 2015, a total of 89 deaths were reported people living with HIV
infection in Minnesota. The total number of deaths 5 reported in Minnesota for those
living with AIDS was 66 (74% of all deaths) in 2015.
4
Includes all deaths known to have occurred among all people living with HIV infection in Minnesota, regardless of location
of diagnosis and cause of death.
5
Number of deaths known to have occurred among people living with AIDS in Minnesota in a given calendar year, regardless
of location of diagnosis and cause of death
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